From the Guidelines
Capecitabine (Xeloda) commonly causes several side effects that require careful management, with hand-foot syndrome being the most frequent adverse event, occurring in 73.4% of patients, including 11.1% with a grade 3 event 1. The most frequent side effects of Capecitabine include:
- Hand-foot syndrome (palmar-plantar erythrodysesthesia), which presents as redness, swelling, and pain in the palms and soles
- Diarrhea
- Nausea and vomiting
- Fatigue
- Mouth sores (stomatitis) Other potential side effects include decreased appetite, abdominal pain, skin rash, and nail changes. More serious but less common side effects include neutropenia (low white blood cell count), thrombocytopenia (low platelet count), and cardiotoxicity. Management of hand-foot syndrome involves using moisturizing creams, avoiding hot water and tight shoes, and possibly reducing the dose if symptoms are severe, as recommended by the 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) 1. For diarrhea, prompt treatment with loperamide (Imodium) is recommended, along with adequate hydration and electrolyte replacement. Nausea and vomiting can be managed with antiemetics like ondansetron or prochlorperazine. Stomatitis may be alleviated with salt water rinses and maintaining good oral hygiene. For severe side effects (grade 3-4), temporary dose reduction or interruption may be necessary, and the recommended dose of capecitabine is 1,000 mg/m2 orally twice daily, as supported by the NCCN clinical practice guidelines in oncology 1. Patients should be monitored regularly with blood tests to check for bone marrow suppression and liver function. Capecitabine is a prodrug that converts to 5-fluorouracil in the body, particularly in tumor tissues, which explains its side effect profile similar to intravenous 5-FU but with some advantages in tissue specificity.
From the FDA Drug Label
The most common side effects of XELODA are: – diarrhea, nausea, vomiting, sores in the mouth and throat (stomatitis), stomach area pain (abdominal pain), upset stomach, constipation, loss of appetite, and too much water loss from the body (dehydration). – hand-and-foot syndrome (palms of the hands or soles of the feet tingle, become numb, painful, swollen or red), rash, dry, itchy or discolored skin, nail problems, and hair loss – tiredness, weakness, dizziness, headache, fever, pain (including chest, back, joint, and muscle pain), trouble sleeping, and taste problems
The side effects of Capecitabine (Xeloda) include gastrointestinal symptoms such as diarrhea, nausea, and vomiting, as well as dermatological symptoms like hand-and-foot syndrome and rash. Additionally, patients may experience general symptoms including tiredness, weakness, and headache.
- To manage these side effects, the dose of XELODA may need to be individualized to optimize patient management.
- Patients should be carefully monitored for toxicity, and doses of XELODA should be modified as necessary to accommodate individual patient tolerance to treatment.
- The dose modification scheme for XELODA is recommended for the management of adverse events, including interrupting treatment until resolved to grade 0-1, and resuming at a reduced dose if necessary 2.
- Prophylaxis for toxicities should be implemented where possible 2.
From the Research
Capecitabine Side Effects
- Diarrhea
- Stomatitis
- Nausea
- Alopecia
- Neutropenia
- Hand-foot syndrome (HFS) 3, 4, 5, 6
- Stevens-Johnson syndrome (SJS) 5, 7
- Hyperbilirubinemia 5
- Mucositis 7
- Hyperpigmentation 7
- Itching 7
- Scrotal mucosal peeling 7
Management of Capecitabine Side Effects
- Temporary interruptions or dose modifications of capecitabine can resolve side effects without reducing the overall efficacy of the treatment 3, 4, 6
- Topical emollients and creams, systemic and topical corticosteroids, nicotine patch, vitamin E, pyridoxine, and COX-2 inhibitors have been studied as potential treatments for HFS, but their efficacy is not well established 4
- Supportive measures to reduce pain and discomfort and prevent secondary infection are important in managing HFS 4
- Systemic steroids can be effective in treating SJS 5, 7
- Patient education on recognizing symptoms of side effects and seeking prompt medical attention is crucial in managing capecitabine side effects 3, 6